Endothelial glycocalyx degradation is associated with early organ impairment in polytrauma patients

Abstract

Background Endothelial glycocalyx (EG) abnormal degradation were widely found in critical illness. However, data of EG degradation in multiple traumas is limited. We performed a study to assess the EG degradation and the correlation between the degradation and organ functions in polytrauma patients. Methods A prospective observational study was conducted to enroll health participants (control group) and polytrauma patients (trauma group) at a University affiliated hospital between Feb 2020 and Oct 2020. Syndecan1 (SDC1) and heparin sulfate (HS) were detected in serum sample of both groups. In trauma group, injury severity scores (ISS) and sequential organ failure assessments (SOFA) were calculated. Occurrences of acute kidney injury (AKI), trauma-induced coagulopathy (TIC) within 48 h and 28-day all-cause mortality in trauma group were recorded. Serum SDC1 and HS levels were compared between two groups. Correlations between SDC1/HS and the indicators of organ systems in the trauma group were analyzed. ROC analyses were performed to assess the predictive value of SDC1 and HS for AKI, TIC within 48 h, and 28-day mortality in trauma group. Results There were 45 polytrauma patients and 15 healthy participants were collected, totally. SDC1 and HS were significantly higher in trauma group than in control group (69.39 [54.18–130.80] vs. 24.15 [13.89–32.36], 38.92 [30.47–67.96] vs. 15.55 [11.89–23.24], P < 0.001, respectively). Trauma group was divided into high degradation group and low degradation group according to SDC1 median. High degradation group had more severe ISS, SOFA scores, worse organ functions (respiratory, kidney, coagulation and metabolic system), and higher incidence of hypothermia, acidosis and shock. The area under the receiver operator characteristic curves (AUC) of SDC1 to predict AKI, TIC occurrence within 48 h and 28-day mortality were 0.838 (95%CI: 0.720–0.957), 0.700 (95%CI: 0.514–0.885) and 0.764 (95%CI: 0.543–0.984), respectively. Conclusions EG degradation was elevated significantly in polytrauma patients, and the degradation was correlated with impaired respiratory, kidney, coagulation and metabolic systems in early stage. Serum SDC1 is a valuable predictive indicator of early onset of AKI, TIC, and 28-day mortality in polytrauma patients.

The endothelial glycocalyx in critical illness: A pediatric perspective

“…Only a few studies have reported biomarkers of EG degradation and pathologic activation of the endothelium following pediatric trauma [163] , [164] . Glycocalyx shedding has been reported within minutes of trauma in adults [165] and is associated with early organ dysfunction [166] . Glycocalyx damage also appears to be an early event after pediatric trauma as suggested by elevated plasma SDC1 levels in injured children measured upon hospital arrival [163] .…”

Circulating Syndecan-1 Levels Are Associated with Chronological Coagulofibrinolytic Responses and the Development of Disseminated Intravascular Coagulation (DIC) after Trauma: A Retrospective Observational Study

“…The endothelial glycocalyx maintains vascular homeostasis: that is, regulation of vascular permeability, inhibition of microvascular thrombosis, and regulation of leukocyte adhesion [ 8 , 10 ]. Degradation of the endothelial glycocalyx has been observed in various critical situations, including sepsis [ 23 , 24 , 25 , 26 , 27 ], trauma [ 12 , 13 , 14 , 16 , 17 , 18 ], malignancy, and cardiovascular diseases, among others [ 8 , 9 , 28 ]. Degradation of the glycocalyx releases the components such as SDC-1 into the blood stream; thus, circulating SDC-1 may serve as a biomarker of endotheliopathy.…”

“…Recent studies of sepsis have demonstrated an association between SDC-1 levels and the development of DIC [ 24 , 38 ]. TIC has been reported to be associated with SDC-1 elevation [ 18 , 39 ], but the relationship between development of DIC and SDC-1 levels is not fully understood. TIC is distinct from other coagulopathies such as sepsis-induced coagulopathy, but dysregulated coagulofibrinolytic response induces progression to the final pathway of DIC [ 35 , 36 ].…”

“…The pathogenesis of TIC is multifactorial, but some previous studies have suggested that endotheliopathy of trauma contributes to the development of coagulopathy [ 14 , 16 , 18 ]. However, the association of SDC-1 levels with comprehensive and chronological coagulofibrinolytic responses in the early phase of trauma has not been fully evaluated.…”

The Endothelial Glycocalyx: Physiology and Pathology in Neonates, Infants and Children

“…Shedding of the glycocalyx has been observed in many acute and chronic diseases in adults characterized by inflammation, endothelial dysfunction and microangiopathy, indicating its crucial role in the homeostasis of the microvasculature. In addition, acute events such as surgery or trauma have been shown to affect the glycocalyx, and patient outcome seems to be directly related to the extent of glycocalyx damage ( Ostrowski and Johansson, 2012 ; Qi et al, 2021 ). In the pediatric population, information on disease-related EG alterations is still limited.…”